The thoracolumbar junction (T11–L2) poses an anatomical dilemma, given the presence of the lower rib cage and the diaphragm when performing anterolateral approaches. To circumvent dealing with the diaphragm, a minimally invasive lateral extracoelomic approach has been used to approach the thoracolumbar junction by mobilizing the diaphragm anteriorly. No anatomical studies have described the attachments of the diaphragm and their surgical significance during the lateral approach to the thoracolumbar spine. The objective of this study is to describe the anatomical relationship of the diaphragm in reference to the minimally invasive lateral approach to the thoracolumbar spine and its surgical significance.
Nine adult fresh-frozen cadaveric specimens were dissected and studied (18 sides). All specimens were placed in the lateral decubitus position, similar to the surgical technique, for the dissections. The relationship between the retroperitoneum, retropleural space, diaphragm, and thoracolumbar spine was analyzed in reference to the minimally invasive lateral approach. Special attention was given to the attachments of the diaphragm and their relationship to the ribs during the early stages of the approach.
All 18 sides were successfully dissected, analyzed, and photographed. The diaphragm is a musculotendinous sheet extending between the thoracic and abdominal cavities. Its attachments can be divided into 3 main categories: 1) sternal or anterior, 2) costal or lateral, and 3) lumbar or posterior. These attachments are described in detail, with specific reference to the lateral approach. When performing the minimally invasive lateral extracoelomic approach to the thoracolumbar spine, the lateral and posterior attachments must be identified and dissected to successfully mobilize the diaphragm anteriorly.
The diaphragm has multiple attachments that can be categorized as anterior, lateral, and posterior. In reference to the minimally invasive lateral extracoelomic approach to the thoracolumbar junction, the surgically significant attachments are primarily to the 12th rib and transverse process of L-1.
Address correspondence to: Elias Dakwar, M.D., 2 Tampa General Circle, 7th Floor, Tampa, Florida 33606. email: firstname.lastname@example.org.Please include this information when citing this paper: published online January 6, 2012; DOI: 10.3171/2011.12.SPINE11626.
ScheuflerKM: Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation. Neurosurgery61:798–8092007
ScheuflerKM: Technique and clinical results of minimally invasive reconstruction and stabilization of the thoracic and thoracolumbar spine with expandable cages and ventrolateral plate fixation. 61:798–809, 2007)| false
SmithWDDakwarELeTVChristianGSerranoSUribeJS: Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. Spine (Phila Pa 1976)35:26 SupplS338–S3462010
SmithWD, DakwarE, LeTV, ChristianG, SerranoS, UribeJS: Minimally invasive surgery for traumatic spinal pathologies: a mini-open, lateral approach in the thoracic and lumbar spine. 35:26 SupplS338–S346, 2010)| false